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Harold Varmus, the director of the National Institutes of Health (NIH), last week turned to 25 individuals — from an Illinois farmer's wife to a former African ambassador — for advice on establishing a Council of Public Representatives.

The move represents Varmus's swift response to a report published three months ago by the Institute of Medicine (IOM) at the request of Congress that criticized the NIH for failing to communicate effectively with the public (see Nature 394, 111; 1998).

The council, which Varmus hopes to have in place within six months, was recommended by the IOM report as a way of improving relations between the NIH and the public by getting ordinary people's opinions directly to Varmus.

Addressing a public meeting of the 25 individuals, Varmus added that he has already implemented another of the report's recommendations by establishing public liaison offices in all 24 NIH institutes and centres. And he is also acting on another IOM suggestion: adding public members to the director's advisory committee.

While Varmus stressed that the IOM had issued “recommendations, not orders”, he said that the NIH “can always do better” with public relations, and he sees a valuable role for the new council. “It would be very helpful to me as we go through debates about issues where science touches society that I have some standing body that has more public participation, that can give me advice,” he said.

In the course of the day-long meeting, however, it became clear that defining the role and composition of the body will not be simple. Some participants wanted the group to have a clear hand in advising Varmus on research priorities, the larger subject of the IOM report.

Others, however, argued that it would not be scientifically equipped for such a role, and would be more effective focusing on broader issues, such as the public's concerns about medical privacy.

Rashi Fein, a professor of the economics of medicine at Harvard Medical School, suggested that the group should focus on “certain gaps in the sensitivity of the medical science community”. But Amalie Ramirez, associate director of the Baylor College of Medicine Center for Cancer Control Research in San Antonio, Texas, was worried that the council might then be relegated to a “public relations function”.

Still others argued that neither the council nor the public liaison offices address what they perceive as the problem underlying NIH's public relations efforts: the agency's apparent blindness to perceived imbalances in how it distributes its $14 billion annual budget among diseases.

But Varmus cautioned against a council structured in such a way that meetings became “a divisive debate among constituencies wanting bigger shares of the pie”. He called for the group to help develop membership criteria that would offer him “protection” from the demands of various advocacy groups to be included in the council.